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June 4, 2008

Lung Cancer Staging With Minimally Invasive Endoscopic Techniques

JAMA. 2008;299(21):2509-2511. doi:10.1001/jama.299.21.2509-b

To the Editor: Dr Wallace and colleagues1 discussed the role of minimally invasive endoscopic diagnostic procedures in the work-up of enlarged and positron emission tomography (PET)–positive mediastinal lymph nodes in patients with suspected lung cancer. They compared 3 different endoscopic procedures (TBNA; endoscopic ultrasound-guided fine-needle aspiration, EUS-FNA; and EBUS-FNA) in 138 patients, reporting a high sensitivity (93%) and negative predictive value (97%) for the combination of EUS-FNA and EBUS-FNA. They concluded that these minimally invasive procedures may be a substitute for mediastinoscopy in selected cases. We would like to raise some concerns about this study.